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How long does it take to do a spinal anaesthetic procedure: a pragmatic, observational study
Abstract Number: S-28
Abstract Type: Original Research
Neural axial anaesthesia has become the anaesthetic of choice in obstetric anaesthetic practice but general anaesthesia remains the quickest technique to deliver the baby. With body mass index (BMI) of pregnant women increasing this can lead to dilemmas and conflict between anaesthetists and obstetricians in balancing the need for quick delivery due to urgency and the need for safety of the mother. Often this stems from the perceived delay caused by the spinal anaesthetic procedure when compared to a general anaesthetic technique. We carried out a pragmatic and prospective observational study to evaluate how long it takes to do the spinal anaesthetic procedure from the time the patient arrives in the operating theatre. Other outcomes evaluated were the variation within Caesarean section (C/S) urgency categories and increasing BMI, time to adequate block height and surgical time to deliver the baby. Study was approved by hospital audit department for ethical issues.
Following a small pilot 112 patients were studied. The following times were noted; arrival in theatre, spinal injection or tracheal intubation, knife to skin and delivery time. From these the following time durations were calculated; arrival to spinal injection or intubation (T1), spinal injection or intubation to KTS (T2), KTS to delivery (T3) and overall time (T4). Also noted was patients’ BMI and urgency of operation for C/S.
Median T1, T2, T3 and T4 for category 1 C/S spinal procedure were 9:30 min, 8:30 min, 4:00 min, and 22:30 min respectively. Median T1 for categories 2, 3, and 4 were 11:30 min, 14:30 min and 14:00 min respectively. Median T1 for BMI categories <20, 21-25, 26-30, 31-35, 36-40 and >40 were 12:30 min, 11:00 min, 14:00, 14:00 min, 10:00 min and 14:30 min respectively. There were 5 GAs with a median T1 of 6:00 min and 8 CSEs with median T1 of 15:30 min.
The spinal anaesthetic procedure is quick enough for a category 1 urgency C/S within our current standard target of delivering the baby within 30 mins from decision time were appropriate. General anaesthesia remains the quickest way to anaesthetise a mother but is associated with more morbidity and mortality. Communication with obstetric staff is very important in minimising other factors affecting decision delivery time and conferring urgency of delivery if we are to avoid unnecessary GAs.